Disseminated Intravascular Coagulation in Emergency Medicine Differential Diagnoses

  • Author: Joseph U Becker, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Oct 26, 2011
 
 

Differential Diagnoses

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Contributor Information and Disclosures
Author

Joseph U Becker, MD  Fellow, Global Health and International Emergency Medicine, Stanford University School of Medicine

Joseph U Becker, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Avishek Kumar, MD  Resident Physician, Department of Internal Medicine, St Michael's Medical Center, Seton Hall University School of Health and Medical Sciences

Avishek Kumar, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Hamid Salim Shaaban  MD, Fellow in Hematology/ Oncology, Department of Internal Medicine, Seton Hall University School of Health and Medical Sciences

Hamid Salim Shaaban is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Charles R Wira, MD  Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale School of Medicine

Charles R Wira, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven A Conrad, MD, PhD  Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center

Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeffrey L Arnold, MD, FACEP  Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Mary A Furlong, MD, and Brendan R Furlong, MD, to the development and writing of this article.

References

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Table 1. Main Features of DIC in a Series of 118 Patients[31]
Features Affected Patients, %
Bleeding64%
Renal dysfunction25%
Hepatic dysfunction19%
Respiratory dysfunction16%
Shock14%
Central nervous system dysfunction2%
Table 2. DIC Score[1]
Risk assessmentDoes the patient have an underlying disorder (eg, sepsis, trauma, obstetric emergency) compatible with DIC?
Laboratory coagulation testsPlatelet count



D-dimer and FDPs



Fibrinogen



PT and aPTT



ScoringPlatelet count: >100 = 0 points, < 100 = 1 point, < 50 = 2 points



Elevated fibrin marker: No elevation = 0 points, moderate increase = 2 points, strong increase = 3 points



Prolonged PT: < 3 sec = 0 points, >3 < 6 = 1 point, >6 = 2 points



Fibrinogen level: >1 g/L = 0 points, < 1 = 1 point



Calculate scoreGreater than or equal to 5 = compatible with overt DIC, repeat scoring daily



Less than 5 suggestive of non-overt DIC



Table 3: Scoring System for DIC (Japanese Association for Acute Medicine)[47]
Clinical conditions that should be ruled out
Thrombocytopenia



Dilution and abnormal distribution



Massive blood loss, massive infusion



Idiopathic thrombocytopenic purpura (ITP), TTP/HUS, HIT, HELLP



Disorders of hematopoiesis



Liver disease



Hypothermia



Spurious laboratory results



Diagnostic algorithm for systemic inflammatory response syndrome
Temperature >38ºC or < 36ºC



Heart rate >90 beats per minute



Respiratory rate >20 breaths/min or PaCO2 < 32 torr (< 4.3 kPa)



White blood cell >12,000 cells/mm3, < 4000 cells/mm3, or 10% immature (band) forms



Diagnostic algorithm



Systemic inflammatory response system criteria



Score
>31
0-20
Platelet count (109/L)
< 80 or >50 % decrease within 24 hours3
>80 and < 120 or >30% decrease within 24 hours1
>1200
Prothrombin time (value of patient/normal value)
>1.21
< 1.20
Fibrin/fibrinogen degradation products (mg/L)
>253
>10 and < 251
< 100
Diagnosis



4 points or more



DIC
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